THE BEST TREATMENT: Radiation therapist Susan Mortensen, who works at the Edmonton Cross Cancer Institute, recently won an award for professional excellence and patient care.
Photo by Dustin Delfs
In Treatment Unit 8 at Edmonton’s Cross Cancer Institute, Susan Mortensen and her colleague, Gurnaib Brar, prepare a 72-year-old grandmother with a Stage 2 colorectal tumour for radiation therapy. The patient has already checked in and changed into a gown when she is called for her turn in the treatment room. Mortensen and Brar consult a screen in the large radiation treatment room, one of the 10 radiation rooms at the Cross where 300 patients receive treatment each day. Despite the pink cupboards, the rest of the room is vault-like, with thick cement and metal walls to protect against the dose of radiation that its centrepiece – the linear accelerator – will deliver.
Mortensen chats with the patient. A screen shows the patient’s exact positioning, from the angle of her back to the incline of her legs. Brar shifts the patient’s legs over a clear plastic leg rest. The pair also consults small tattoos on the patient’s midsection to position the linear accelerator in a way that will pinpoint her tumour, leaving the surrounding healthy tissue largely untouched. “There’s no room for error,” Mortensen says. It’s noteworthy, then, that the patient smiles as Mortensen leaves her alone in the room, pulling the heavy door closed behind her.
Maybe the patient’s calm is due to the fact that she’s halfway through her 25 treatments. But the care that Mortensen and her colleagues deliver – alongside a dose of the strongest medicine that people receive – goes a long way to putting their patients at ease.
Radiation therapy is a mainstay of cancer care and up to 40 per cent of cancer patients will receive it. There are multiple kinds of radiation therapy. The therapy the grandmother on Unit 8 is receiving is delivered externally, via the linear accelerator. Brachytherapy is a kind of radiation treatment that’s delivered internally, by temporarily placing radioactive material in, or near, a cancer site. Before the patient receives any therapy a team, supervised by a radiation oncologist, maps out the patient’s cancer in detail, using MRI and CT scans for a clear picture. Therapists, such as Mortensen, Brar and Winston Poon, their colleague on Unit 8, double check details including dosage, duration and frequency and, if necessary, they flag concerns to the oncologist.
Outside the treatment room, Mortensen and the team watch the patient through a monitor and adjust the controls. Then they hit the switch. “She doesn’t feel anything,” Mortensen says. Seated at the monitor, Poon makes some adjustments to the computer in front of him and the drum of the big machine pivots to a different treatment angle. “The side effects, including generalized fatigue, are minimal,” Mortensen says. A few minutes later, the patient’s treatment is finished.
The effects of the radiation on the tumour are more significant. It kills cancer cells by damaging their DNA, making it impossible for them to divide and grow, uncontrolled cellular growth being cancer’s hallmark. “We deliver therapy, sometimes daily, for several weeks,” Mortensen says. The repeated, low dose ensures that cancer cells are hit at vulnerable times during their cell cycle, allowing normal tissue to repair itself. It also means that patients have plenty of time to get to know radiation therapists, like Mortensen, as they see them daily during the treatment cycle.
Mortensen graduated from the Cross Cancer Institute’s school of radiation therapy in 1982 and, after half a decade of delivering patient care, she received the Alberta College of Medical Diagnostic and Therapeutic Technologists award for Professional Excellence in Patient Care in May. “She works humour and empathy into her practice,” says her nominator, Susan Fawcett. “She takes pride in her work and her practice is always patient-centred.”
Fawcett, Alberta’s radiation therapy professional practices and academic leader, says that young people in Alberta aspiring to become therapists today generally need at least a year in a pre-professional field at university. Then they receive 11 months of classroom work, followed by 17 months of practical training at the Cross Cancer Institute in Edmonton or its Calgary counterpart, the Tom Baker Cancer Centre. She predicts that students hoping to become radiation therapists will require a degree in the future, as Alberta is the only province that doesn’t currently require one.
Post-secondary certification is just the start of a career in radiation therapy. Radiation therapy changes at the speed of technology and Fawcett says that one of the reasons she nominated Mortensen for the award was for Mortensen’s drive to stay up-to-date in her knowledge. Mortensen and her colleagues are continually reading about new developments in their practice, talking to each other and networking with colleagues elsewhere. They take courses and attend conferences, too, but technology is just one aspect of the field. “To do this job, you have to be tech smart and people savvy,” Mortensen says.
Patient James McLaughlin agrees. “Just hearing the word ‘cancer’ is scary,” he says. Mortensen goes a long way to make the process as comfortable as possible. “She asked me about my hobbies and, when I mentioned golf, we segued into a conversation about that.” Now halfway through a course of radiation therapy for esophageal cancer, McLaughlin is making daily trips to the Cross. “She never hurries me through and really tries to put my mind at ease,” he says.
It’s that near-daily contact that builds relationships. “Patients tell us things they’ve forgotten, or were hesitant to mention to their doctors,” Mortensen says. Therapists can flag potential problems, or make referrals to other cancer care personnel, such as dieticians. “We work hard to make patients feel unique,” she says.
McLaughlin, 60, agrees. “There are so many resources,” he says, “and so much support available.” He advises other patients faced with radiation therapy to ask as many questions as possible, not just of their oncologist, but of therapists such as Mortensen.
Mortensen’s colleague Poon agrees that she delivers top care. “It’s very busy here and a therapist has to work well in a team,” he says, “and Susan always approaches each patient as a unique person, not just a 10:15 appointment for a procedure.”